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Vulval CIN
and cancer (Clinical
presentation (Itch, Ulcers, Pain,…
Vulval CIN
and cancer
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Pathophysiology
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Cancerous change
Dysplasia of squamous vulval epithelium (VIN)
Risk of cancer progression to vulval carcinoma
May also have cervical Ca
Histology
VIN: I is non-specific inflammatory change, VIN II-III is true VIN
Padget's disease of the vulva
Cancers - squamous cells carcinomas, melanomas, basal cell
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Diagosis
Examination
Pelvic
Raised/hyperkeratotis, warty, erythematous lesion
on the vulva skin, often at multiple sites
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Investigations
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Bedside
Obs (sats, RR, HR, BP, temp)
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History
DH
Current meds, allergies
PMH
Known conditions, surgery
POH
Gravity/parity, delivery, complications
PGH
Known conditions, menses, bleeding,
contraception, STIs, smears
PC/HPC
Itching, pain, lesions, weight loss,
bleeding, discharge, urinary/bowel
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SH
Occupation, smoking, alcohol
Staging (FIGO)
Stage 2
Spread to adjacent vagina, urethra, anus
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Stage 1
Limited to vulva/peritoneum,
minimal invasion
Stage 4
Mets to urethra, bladder, bowel, bones, distant
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Management
Medical
Immunotherapy
Indication: VIN
E.g. topical imiquimod
MOA: immune modifier, aiding virus clearance by stimulating macrophages resulting in Th cell recruitment
SEs: soreness, burning
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Radiotherapy
Indication: neoadjuvantadjuvant to surgery for cancer
E.g. external beam RT
MOA: alone or combined with chemotherapy
Surgical
Excision
Indication: painful/irritating VIN, vulval cancer
MOA: removal of macroscopic tumour
by vulvectomy and wide local excision
Complications: bleeding, infection, lymphoedema, VTE
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Conservative
Information, advice, support
Surveillance (clinical)
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